Journal of evaluation in clinical practice
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Despite advocacy by diabetes societies and evidence about how to prevent the deleterious consequences of dysglycemia among hospitalized patients, deficits in clinical practice continue to present barriers to care. The purpose of this study was to examine inpatient rounding practices using a qualitative research lens to assess challenges on the care of hospitalized patients with diabetes and to develop ideas for positive changes in hospital management of diabetes and hyperglycemia. ⋯ This work guides clinicians and informs systems of practice about improvement strategies that can emerge from within hospital teams. These recommendations emphasize the interconnectedness of practice elements including thoughtful review of glucose status during rounds among patients with and without diabetes; fostering doctors and nurses to work in unison; promoting awareness and integration within and across disciplines; and advocating for better use of existing resources.
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Comparative Study
Substance use screening and brief intervention: Evaluation of patient and implementation differences between primary care and emergency department settings.
There are well-documented barriers that have limited widespread, sustained adoption of screening and brief intervention for risky substance use in health care settings. In order to better inform implementation efforts, this study evaluates whether patient characteristics, screening results, and implementation success indicators differed between two clinical setting types: primary care and emergency. ⋯ This evaluation found important differences in patient characteristics and screening and implementation results between primary care and emergency settings. Health care organizations and administrators implementing screening and brief intervention should attend to setting differences that could affect implementation and clinical care.
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The spectrum of cases seen by emergency departments ranges from minor illnesses or injuries to complex diseases with high mortality. Some patients require life-saving interventions (LSIs) or therapeutic treatment for an acute illness to prevent an expected imminent life-threatening condition immediately upon arrival. No published study has evaluated the validity of the Manchester Triage System (MTS) in the context of immediate LSI or acute emergency treatment (AET). ⋯ The MTS is a valid instrument for a first assessment of emergency patients in critical condition upon arrival.
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Observational Study
Development of a proforma to improve quality of handover of surgical patients at the weekend.
The introduction of shift pattern of working in the medical profession has led to an increase in reliance on effective handover of patient information. We evaluated the use of a weekend handover proforma in General Surgical patients at a University Teaching Hospital. ⋯ Effective transfer of handover information can be achieved over the weekend with the use of a standardized proforma. Use of the proforma was greatest after providing junior doctors with didactic training on handover combined with interactive guidance on completing the proforma.
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Many hospitals provide some type of real time publicly available information about the crowding of the emergency departments (EDs). For example, at the time of writing, the number of patients waiting and in treatment is publicly available for EDs that cover more than half of the Italian population. However, usually, these data do not provide the key information that low-priority patients are seeking, which is the time they might expect to wait before being seen by a doctor. ⋯ The results suggest that available data should be used to develop and validate ED-specific waiting time prediction models of low-priority patients. The same data could also be used to estimate quantities that might be of interest for EDs resource management.